Provider Demographics
NPI:1952323248
Name:HANSEN, INGE MARGRETHE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:INGE
Middle Name:MARGRETHE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DANZIG PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7979
Mailing Address - Country:US
Mailing Address - Phone:925-685-9463
Mailing Address - Fax:925-685-9682
Practice Address - Street 1:1410 DANZIG PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7979
Practice Address - Country:US
Practice Address - Phone:925-685-9463
Practice Address - Fax:925-685-9682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18863103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY188630Medicaid
CAOPL188630Medicare ID - Type UnspecifiedPSYCHOLOGIST